Measurement Of Total IgE Research Articles

Probiotic supplementation in the first 6 months of life in at risk Asian infants – effects on eczema and atopic sensitization at the age of 1 year

The role of probiotics in allergy prevention remains uncertain but has been shown in some studies to have a possible protective effect on eczema. We aimed to assess the effect of probiotic supplementation in the first 6 months of life on eczema and allergic sensitization at 1 year of age in Asian infants at risk of allergic disease. A double-blind, placebo-controlled randomized clinical trial involving 253 infants with a family history of allergic disease was carried out. Infants received at least 60 mL of commercially available cow's milk formula with or without probiotic supplementation [Bifidobacterium longum (BL999) 1 x 10(7) colony forming unit (CFU)/g and Lactobacillus rhamnosus (LPR) 2 x 10(7) CFU/g] daily for the first 6 months. Clinical evaluation was performed at 1, 3, 6 and 12 months of age, with serum total IgE measurement and skin prick tests conducted at the 12-month visit. The primary and secondary end-points were eczema and allergen sensitization, respectively. The incidence of eczema in the probiotic (22%) group was similar to that in the placebo group (25%) (P=0.53). The median Scoring Atopic Dermatitis score at 12 months was 17.10 (9.74) in the probiotic group and 11.60 (8.40) in the placebo group (P=0.17). The prevalence of allergen sensitization showed no difference (probiotic=24% vs. placebo=19%, P=0.26). The total IgE geometric mean (95% confidence interval) was 18.76 (12.54-24.98) kU/L in the probiotic group and 23.13 (16.01-30.24) kU/L in the placebo group (P=0.15). Atopic eczema (with sensitization) in the probiotic (7.3%) group was comparable to the placebo group (5.8%) (P=0.86). Early life administration of a cow's milk formula supplemented with probiotics showed no effect on prevention of eczema or allergen sensitization in the first year of life in Asian infants at risk of allergic disease. Further work is needed to determine whether timing of supplementation, dose and probiotic strain are important considerations.

Cord serum immunoglobulin E as a risk factor for allergic symptoms and sensitization in children and young adults

Early markers of atopic predisposition are needed for targeting allergy preventive measures to high-risk infants. An elevated cord serum immunoglobulin E (CS-IgE) level is considered a risk factor for subsequent allergy in childhood. However, the previous studies have not assessed the predictive value of CS-IgE in a follow-up extended to adulthood. We aimed at clarifying whether CS-IgE is useful in predicting subsequent atopic manifestations up to age 20 yr. A cohort of 200 unselected, full-term newborns were prospectively followed up from birth to age 20 yr. The CS-IgE level was successfully measured in 190 subjects at birth. The subjects were re-examined at ages of 5, 11 and 20 yr with assessment of the occurrence of allergic symptoms during the preceding year, skin prick testing and measurement of serum total IgE. An elevated CS-IgE level was associated with allergic symptoms and skin prick test positivity at age 5 yr (p = 0.03 and 0.01), with allergic rhinoconjunctivitis at age 20 yr (p = 0.04) and with an elevated serum total IgE at ages of 11 and 20 yr (p = 0.02 and 0.01). The sensitivity of CS-IgE, i.e. the probability of an elevated CS-IgE in an infant who subsequently develops atopy, in predicting skin prick test-verified atopy at ages of 5 and 20 yr was 50% and 26%, respectively. The combination of elevated CS-IgE and positive family history of allergy was strongly associated with subsequent atopic manifestations. Nevertheless, it showed a reduced sensitivity as compared to CS-IgE or family history of allergy. We conclude that an elevated CS-IgE level predicts subsequent atopy up to age 20 yr.

A micro-ELISA system for the rapid and sensitive measurement of total and specific immunoglobulin E and clinical application to allergy diagnosis

We have developed a novel, practical micro-ELISA system for sensitive and rapid allergy diagnosis. The enzymatic reactions occurred under stopped-flow conditions, resulting in both high precision and high sensitivity. A BSA-biotin-avidin linker was introduced for the immobilization of water-soluble allergens on polystyrene microbeads, enabling immobilization of allergens in sufficient density to provide high sensitivity. Evaluation of the system's performance showed a good detection limit (2 ng/mL) for total IgE measurement. In addition, a good correlation with a conventional method (CAP method) was demonstrated using human serum samples from 85 allergy patients. Importantly, sample volumes (5 microL) were 10 times smaller and analysis time (12 min) was >20 times faster than the conventional method. All procedures were automatically regulated with our simple microfluidic system, and all the fluidic, optic and electronic components were integrated for portability. We believe that our system has the potential to become a very powerful tool, particularly for point-of-care diagnosis.

Diagnostik der Allergien vom Soforttyp – „State of the Art”

Bei allergischen Erkrankungen kommt der Differenzialdiagnostik, die aus den Schritten Anamnese, Hauttest, in-vitro-Diagnostik und Provokationstest bestehen sollte, eine zentrale Bedeutung zu. Die zweifellos wichtigste und praxistauglichste in-vitro-Untersuchung ist die Bestimmung von allergenspezifischen IgE-Antikörpern (sIgE) im Serum. Der Nachweis von sIgE bedeutet, dass eine spezifische Sensibilisierung gegenüber entsprechenden Allergenen vorliegt. Die Aussagekraft der Allergiediagnostik ist massiv von der Qualität der verwendeten Allergenextrakte und der Methoden abhängig. Im Falle der Allergiediagnostik hat die alleinige Bestimmung des Gesamt-IgEs keinen diagnostischen Wert, da damit keine Aussage zur spezifischen Sensibilisierung getroffen werden kann. Sie kann allerdings als Interpretationshilfe zur Beurteilung der allergenspezifischen IgE-Konzentrationen im Patientenserum dienen und gibt ergänzende Hinweise auf das Vorliegen einer allergischen Disposition. Die Bildung von allergenspezifischen IgG-Antikörpern ist Teil der normalen Immunantwort auf eine Fremdstoffexposition. Da keine Korrelation zur klinischen Symptomatik mit der allergischen Soforttypreaktion besteht und ihre Rolle in der Pathogenese des Asthma bronchiale bzw. der Allergie unbekannt ist, gilt die Krankheitsrelevanz der IgG-Antikörper als völlig ungesichert. Für alle zellulären Testsysteme gilt bislang: Sie sind methodisch aufwendig, kostspielig, häufig ungeeignet für den Versand von Proben und anspruchsvoll in Durchführung und Interpretation. Obwohl sie für die Routinediagnostik zum größten Teil wenig geeignet sind, können sie allerdings bei gezielter Indikation, kontrollierter Durchführung und kritischer Interpretation einen potenziellen Baustein für die spezialisierte in-vitro-Allergiediagnostik darstellen. Für die einzelnen Teste sind allerdings Standardprotokolle inklusive Ringversuche und entsprechende Qualitätskontrollen zu fordern. Verwendete Antigene/Allergene müssen charakterisiert und standardisiert werden (Haupt- und Leitallergene). In unklaren Fällen sind alle Möglichkeiten einzubeziehen, sodass eine für den Patienten zielführende Diagnostik vorgenommen werden kann.

The concentration of kynurenine in rat model of asthma.

Asthma is a chronic inflammatory disease that involves the immune system activation. Evidence is accumulating about the role of kynurenine pathway in the immune system regulation. The kynurenine pathway includes several metabolites of tryptophan, among others kynurenine (KYN). To study the immunological system regulation in asthma a simple and sensitive models of asthma are required. In the present study we induced rat model of asthma using ovalbumin (OVA) sensitization followed by challenge with OVA. The development of asthma has been confirmed by plasma total IgE measurement and the histological examination. The concentration of KYN has been determined in plasma, lungs and liver by high-performance liquid chromatography (HPLC). In OVA sensitized rats the concentration of total IgE was statistically significantly increased as compared to VEH sensitized control groups (437.6 +/- 97.7 kU/l vs 159.2 +/- 22.7 kU/l, respectively; p< 0.01). In asthmatic animals, the number of eosinophils, neutrophils and mast cells increased considerably, and epithelial lesion and the increase in airway epithelium goblet cells and edema of bronchial mucosa were present. We did not observe any significant changes in the concentration of KYN in plasma, lungs or liver between studied groups. In conclusion, the concentration of KYN remains unchanged in asthmatic animals as compared to control groups. Further studies using rat model of asthma are warranted to establish the role of kynurenine pathway regulation in asthma.

Paternal Asthma, Mold Exposure, and Increased Airway Responsiveness Among Children With Asthma in Costa Rica

Little is known about the determinants of airway hyperresponsiveness (AHR) among children with asthma in Hispanic America. We examined the relations among selected familial and environmental factors, markers of allergy, spirometric measures of lung function, and AHR in a cross-sectional study of 403 Costa Rican children with asthma between the ages of 6 and 14 years. Study participants completed a protocol that included questionnaires, spirometry, measurements of serum total and allergen-specific IgE, peripheral blood eosinophil count, and body mass index, and the assessment of airway responsiveness to methacholine (ie, a methacholine challenge test [MCT]). AHR to MCT was defined as the provocative dose of methacholine causing a 20% fall in FEV(1). Linear regression was used for the univariate and multivariate analyses. Of the 403 asthmatic children who underwent an MCT, 350 (86.8%) had AHR to methacholine. In a multivariate analysis, paternal asthma (p = 0.004), parental report of mold/mildew in the child's home (p = 0.04), FEV(1)/FVC ratio (p < 0.0001), and a positive IgE response to Der p 1 (p = 0.008) were significantly associated with AHR among Costa Rican children with asthma. Our results suggest that paternal asthma and environmental exposure to mold/mildew are strong determinants of AHR in Costa Rican children with asthma. FEV(1)/FVC ratio may be a useful measure of AHR (a marker of asthma severity) among Costa Ricans and other Hispanic Americans for whom reference values for FEV(1) are not currently available.

Serum cholesterol level in infancy is inversely associated with subsequent allergy in children and adolescents. A 20‐year follow‐up study

Previous studies suggest an association between an altered lipoprotein profile and atopy. The association has been hypothesized to be due to alterations in the dietary fat intake, a factor possibly contributing to the increase of allergic diseases in industrialized countries. We aimed at assessing whether there is an association between the serum lipid levels in infancy and subsequent development of allergic symptoms in childhood and adolescence. A cohort of 200 unselected newborns was prospectively followed up from birth to age 20 years (from 1981 to 2002) with repeated measurements of total cholesterol from birth and throughout the first year of life. The subjects were re-examined at the ages of 5, 11 and 20 years, with assessment of the occurrence of allergic symptoms, skin prick testing (SPT) and measurement of total IgE and of the total, high- and low-density lipoprotein cholesterol. Children and adolescents with allergic symptoms, SPT positivity and an elevated IgE had lower total cholesterol levels in infancy and childhood than the non-atopic subjects. The difference was not detectable in cord blood, but became significant from age 2 months onward. The inverse association between the cholesterol level in infancy and subsequent manifestations of atopy seems not to be due to atopy-related dietary alterations, because it was already present in early infancy, when virtually all the infants were on a similar diet, i.e. on exclusive breastfeeding.

Increasing trend in atopy markers prevalence in a Croatian adult population between 1985 and 1999

Reports about the increasing prevalence of atopy and atopic diseases are common, but recently they have been critically reviewed and the need for relevant research methods has been established. This study evaluated a 15-year trend in the prevalence of atopy markers [elevated total IgE, positive skin prick test (SPT) to common aeroallergens and positive atopic symptoms] in Croatian adults, separately for women and men. The study included 721 subjects (445 men and 276 women), 18-45 years old, examined for allergies within a pre-employment preventive examination. All subjects underwent medical history, SPT with common inhalatory allergens and total serum IgE measurement. The trend analysis of atopy prevalence was performed after stratification of subjects into three consecutive 5-year periods from 1985 to 1999. The prevalence of concurrently elevated total IgE and positive atopic symptoms significantly increased during the studied period in men [odds ratio (OR) 2.44, 95% confidence interval (CI) 1.39-4.29, P=0.002]. Women showed an increased prevalence of positive SPT only, with borderline significance (OR 1.65, 95% CI 1.00-2.71, P=0.050). In women, rural residence was found to be a predictor of elevated total IgE (OR 5.36, 95% CI 2.41-11.93, P=0.000) and smoking to be a predictor of concurrently elevated total IgE and positive SPT (OR 6.20, 95% CI 1.67-23.07, P=0.006). An increasing trend in the prevalence of concurrently elevated total IgE and positive atopic symptoms was found in the Croatian adult male population between 1985 and 1999, but not in the female population. Sex differences responsible for the production and regulation of IgE were suggested.

Chronic rhinosinusitis and allergy

The role of allergic sensitization in chronic sinusitis in childhood is currently unclear, as contrasting results were reported in the studies thus far available. In fact, some surveys found prevalence of atopy up to 60% in subjects with chronic sinusitis, while other failed to confirm any association between the two conditions. The data we obtained in a cross-sectional study on a large population of children should help in better defining such issue. Among 2200 children referring for evaluation of chronic respiratory symptoms, subjects satisfying at least two of major criteria for the definition of chronic sinusitis were recruited, and underwent to allergen sensitization workup by skin prick test with common inhalant allergens and total IgE measurement. Patients were stratified according to age lower than 3 years (group 1), age between 3 and 6 years (group 2), and age above 6 years (group 3). In all, 351 children (217 boys, 134 girls, mean age 5.23+/-2.11 years, range 1.5-15 years) were available for evaluation and formed three groups (27 in group 1, 261 in group 2 and 63 in group 3). Prevalence of both sensitization to at least one inhalant allergen by skin test and of high total IgE was 29.9%, with significant difference for the former across age groups, with a value of 7.4% in group 1, 31.4% in group 2 and 33.3% in group 3 (p=0.028), but after adjusting for age, sinusitis and aeroallergen sensitization were not significantly correlated. The difference across groups for high total IgE did not reach statistical significance, with respective prevalence of 22.7%, 30.1% and 32.1%. It is possible to conclude that the prevalence of sensitization to aeroallergens in children with chronic sinusitis is comparable with that of the general paediatric population, as assessed in the Italian arm of the ISAAC study and this does not account for routine investigation for allergy in children with chronic sinusitis.

No effects of probiotics on atopic dermatitis in infancy: a randomized placebo‐controlled trial

Studies have been performed suggesting that administration of probiotics may have therapeutic and/or preventive benefits in the development of sensitization and atopic disease, particularly in infants with atopic dermatitis (AD). The purpose of this study was to evaluate the clinical and immunological effects of supplementation of a hydrolysed formula with two probiotic strains of bacteria on symptoms of AD in infancy. We conducted a randomized, double-blind, placebo-controlled study. After 4-6 weeks of baseline and double-blind, placebo-controlled challenges for diagnosis of cow's milk allergy (CMA), infants less than 5 months old with AD received a hydrolysed whey-based formula as placebo (n = 17), or supplemented with either Lactobacillus rhamnosus (n = 17) or Lactobacillus GG (n = 16) for 3 months. Before, during and after intervention, the clinical severity of AD was evaluated using SCORing index Atopic Dermatitis (SCORAD). Allergic sensitization was evaluated by measurement of total IgE and a panel of food-specific IgEs as well as skin prick testing for cow's milk. Inflammatory parameters were blood eosinophils, eosinophil protein X in urine, fecal alpha-1-antitrypsin and production of IL-4, IL-5 and IFN-gamma by peripheral blood mononuclear cells after polyclonal stimulation. No statistically significant effects of probiotic supplementation on SCORAD, sensitization, inflammatory parameters or cytokine production between groups were found. Only four infants were diagnosed with CMA. We found no clinical or immunological effect of the probiotic bacteria used in infants with AD. Our results indicate that oral supplementation with these probiotic bacterial strains will not have a significant impact on the symptoms of infantile AD.

Autoantibodies to the high-affinity IgE receptor in children with chronic urticaria

Chronic urticaria (CU) in childhood remains a challenge for investigation, and its etiology is largely unknown. Autoantibodies to the high-affinity IgE receptor (FcepsilonRI) are believed to play a role in the pathogenesis of this disease in adults. To determine the prevalence of autoantibodies to FcepsilonRIalpha on basophils in children with CU vs atopic eczema dermatitis syndrome (AEDS). Eighty children with CU were compared with 38 children with AEDS. In addition to complete blood cell counts and total IgE measurements, CAP-RASTs to egg, codfish, soy, milk, and peanut were performed. Stool samples were examined for parasites, and autologous serum skin testing and a functional anti-FcepsilonRIalpha assay were conducted to detect autoantibodies. No significant differences were observed between children with CU and controls in mean basophil or eosinophil counts. Twenty (26%) of 77 children with CU and 31 (82%) of 38 with AEDS had positive CAP-RAST results (P < .001). Only 2.5% of the children with CU and 0% with AEDS had stool samples positive for parasites (P = .005). Anti-FcepsilonRIalpha autoantibodies were positive in 37 (47%) of 78 children with CU and in none of 33 with AEDS. Non-IgG histamine-releasing factors were found in 10 (13%) of 78 children with CU. Children have a similar prevalence of autoantibodies to the FcepsilonRIalpha as has been previously published for adults. Few have type I allergies, and parasite infestation is also uncommon. Further studies are required to investigate the predictive value of the autoantibodies in these children with respect to clinical profile, requirements for medications other than antihistamines, and remission rates.

Allergic bronchopulmonary aspergillosis in a patient with cystic fibrosis: diagnostic criteria when the IgE level is less than 500 IU/mL

Recently, the Cystic Fibrosis Foundation developed a consensus report recommending diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis that includes a serum IgE level greater than 500 IU/mL as the "minimal diagnostic criterion." To describe a 7-year-old girl with ABPA whose serum IgE level increased to only 398 IU/mL. Total IgE and anti-Aspergillus serologic measurements were performed using enzyme-linked immunosorbent assay and standard laboratory techniques; HLA analysis was performed; interleukin 4 receptor alpha single nucleotide polymorphisms were performed using polymerase chain reaction and DNA sequencing; CD23+ B cells were measured using flow cytometry; and cytokine synthesis to Aspergillus purified antigens was assessed using flow cytometry. A 7-year-old girl with cystic fibrosis who had mild pulmonary disease and well-controlled asthma developed pulmonary infiltrates, increased wheezing, and decreased pulmonary function. Additional studies demonstrated peripheral blood eosinophilia (eosinophil count, 1807 cells/mm3 [19%]) and an increase in IgE and IgG anti-Aspergillus serology; bronchoalveolar lavage revealed septate hyphae with 45 degrees branching subsequently identified as A fumigatus and pulmonary eosinophilia. Previous HLA typing revealed that the patient was HLA-DR2+, DRB*1501, HLA-DQ2-, a pattern associated with increased risk of ABPA. In addition, there was increased up-regulation of CD23 molecules by interleukin 4 stimulation on the patient's B cells, as observed in ABPA. The patient was treated with corticosteroids and itraconazole with resolution of symptoms and pulmonary infiltrates. Examination of the pulmonary inflammatory response using bronchoalveolar lavage, genetic risk with HLA-DR2+DQ2- typing, and increased interleukin 4 sensitivity are useful adjunctive studies in the diagnosis of ABPA.

Prediction of the Development of Tolerance to Milk in Children With Cow’s Milk Hypersensitivity

Vanto T, Helpphla S, Juntunen-Backman K, et al. J Pediatr . 2004;144:218–222 To investigate whether the development of tolerance to cow’s milk (CM) by the age of 4 years can be predicted with a skin-prick test (SPT) and measurements of total or specific IgE in the serum taken at the time of diagnosis of CM hypersensitivity (CMH). Infants with immediate ( n = 95) or delayed ( n = 67) challenge reactions to CM were prospectively followed to 4 years of age. CMH status was assessed annually by CM challenges, …

The association between birth size and atopy in young North‐European adults

There is evidence that atopic disorders may begin in intra-uterine life; however, studies of birth characteristics and atopy show conflicting results. We wanted to investigate the association of birth weight and head circumference with serum total or specific IgE, allergic rhinitis or eczema while addressing the influence of demographic and geographical factors. In this historic prospective cohort study, data were collected from birth records for 1683 men and women born in 1947-1973, from six Nordic-Baltic populations participating in the European Community Respiratory Health Survey. Blood tests for the measurement of serum total and specific IgE were available for 1494 subjects. In multiple regression analyses, adjustments were made for birth length, gender, age, study centre, adult body mass index, level of education, parental and adult smoking. RESULTS There was no association of birth weight (n=1230) and head circumference (n=285) with serum total IgE, specific IgE antibodies, allergic rhinitis or eczema. There were neither significant interactions by gender or age, nor heterogeneity between the study centres in the analyses of birth weight and adult atopy. Birth size was not associated with atopy among adults in this large Nordic-Baltic population study.

Association between atopy and recurrent vaginal candidiasis.

To determine whether there is an association between atopy and recurrent vaginal candidiasis (RVC) and to evaluate the type-2 immune response in patients with RVC. Evaluation of immediate hypersensitivity skin tests to aeroallergens, measurement of total IgE and Candida albicans specific IgE and levels of IL-5 in 44 women with RVC and 26 with sporadic vaginal candidiasis (SVC). Statistical analyses were performed by Mann-Whitney test and chi(2) test with Yates correction. History of atopy (68%) and positive skin test (42%) were higher (P < 0.05) in RVC than in patients with SVC. No significant difference was found in total IgE, C. albicans specific IgE and IL-5 levels. There was a strong association between atopy and RVC, but type-2 immune response to C. albicans antigen was absent or similar in the two groups of patients.

Association of CARD15 polymorphisms with atopy‐related traits in a population‐based cohort of Caucasian adults

Influences of microbial pathogens are crucial for the maturation of the immune system. Caspase-recruitment domain containing protein 15 (CARD15) is a cytosolic receptor involved in bacterial recognition by antigen-presenting cells. CARD15 polymorphisms have been associated with Crohn's disease. Recently, associations with atopic phenotypes have been reported in children. Within a large population of German adults (n=1875), we evaluated eight CARD15 polymorphisms for associations with atopic phenotypes. Subjects were phenotyped by standardized questionnaires and interviews as well as total and allergen-specific IgE measurements. Genotyping was performed using matrix-assisted laser desorption ionization--time of flight mass spectrometry. Haplotypes were estimated using the SAS/Genetics module. Subjects with a T allele at rs1077861 had a decreased risk of developing asthma (odds ratio OR=0.648, P=0.013), whereas the presence of an A allele at rs3135500 was significantly associated with an increased risk (OR=1.374, P=0.023). In addition, a CARD15 haplotype revealed to be protective against the development of asthma (OR=0.326, P=0.003). Subjects with an A allele at position rs5743266 or a T allele at rs2066842 had a significantly decreased risk of developing allergic rhinoconjunctivitis with ORs of 0.820 (P=0.049) and 0.801 (P=0.025). Polymorphism rs2066845 showed a significant association with increased total serum IgE (OR=2.155, P=0.006). Genetic variants of CARD15 that might result in inappropriate immunomodulation are not only associated with autoimmune diseases but also with atopic disorders.

Effect of fungal antigen exposure on airway allergen sensitization

RATIONALE: Repeated exposure to innocuous antigens often induces immunologic tolerance unless if primed with an adjuvant. Fungi, such as Alternaria and Candida, are ubiquitous in the air and their potential pro-inflammatory properties could overcome immunologic tolerance. In this study, we examined the effect of Alternaria and Candida on the airway immune response to OVA using a mouse model.METHODS: BALB/c female mice were exposed intranasally on days 0 and 7 with fungal extracts (Alternaria alternata or Candida albicans), either alone or in combination with OVA. Plasma was obtained on day 14 for measurement of total and OVA-specific IgE and IgG1. The mice were challenged intranasally with OVA on days 21, 22 and 23. Bronchoalveolar lavage fluid was collected on day 24 and analyzed for airway inflammation.RESULTS: Mice exposed to both Alternaria and OVA developed more OVA-specific IgE (0.098±0.034 absorbance at 450 nm (O.D); p=0.053) and IgG1 (0.347±0.033 O.D; p<0.001), and a robust eosinophilic airway inflammatory response (19.8±6.7% of total BAL cells; p<0.05) compared to mice exposed to OVA alone (0.011±0.003, 0.046±0.027 and 2.5±1.3%, respectively). In contrast, mice exposed to both Candida and OVA produced no increase in OVA-specific IgE or IgG1. Furthermore, airway neutrophilia, and not eosinophilia, was observed when mice previously exposed to Candida plus OVA were subsequently exposed to OVA.CONCLUSIONS: Alternaria, but not Candida, is a potent catalyst for Th2-like acquired immunity to bystander antigens. The ability of ubiquitous fungi to enhance airway immune response to bystander antigens may play an important role in mounting an allergic response to aeroallergen. RATIONALE: Repeated exposure to innocuous antigens often induces immunologic tolerance unless if primed with an adjuvant. Fungi, such as Alternaria and Candida, are ubiquitous in the air and their potential pro-inflammatory properties could overcome immunologic tolerance. In this study, we examined the effect of Alternaria and Candida on the airway immune response to OVA using a mouse model. METHODS: BALB/c female mice were exposed intranasally on days 0 and 7 with fungal extracts (Alternaria alternata or Candida albicans), either alone or in combination with OVA. Plasma was obtained on day 14 for measurement of total and OVA-specific IgE and IgG1. The mice were challenged intranasally with OVA on days 21, 22 and 23. Bronchoalveolar lavage fluid was collected on day 24 and analyzed for airway inflammation. RESULTS: Mice exposed to both Alternaria and OVA developed more OVA-specific IgE (0.098±0.034 absorbance at 450 nm (O.D); p=0.053) and IgG1 (0.347±0.033 O.D; p<0.001), and a robust eosinophilic airway inflammatory response (19.8±6.7% of total BAL cells; p<0.05) compared to mice exposed to OVA alone (0.011±0.003, 0.046±0.027 and 2.5±1.3%, respectively). In contrast, mice exposed to both Candida and OVA produced no increase in OVA-specific IgE or IgG1. Furthermore, airway neutrophilia, and not eosinophilia, was observed when mice previously exposed to Candida plus OVA were subsequently exposed to OVA. CONCLUSIONS: Alternaria, but not Candida, is a potent catalyst for Th2-like acquired immunity to bystander antigens. The ability of ubiquitous fungi to enhance airway immune response to bystander antigens may play an important role in mounting an allergic response to aeroallergen.

The Assessment of Validity of Different Asthma Diagnostic Tools in Adults

Background. The diagnosis of asthma is based on the presence of symptoms. Lung function measurements such as forced expiratory volume in one second (FEV1), peak expiratory flow (PEF) variability and airway hyperresponsiveness support the clinical diagnosis. However, asthma is still an under- or overdiagnosed disease. Objectives. The aim of this study was to identify which test(s) is the most valuable for making the diagnosis of asthma by using patients with asthma-like symptoms as a reference population. Methods. One hundred patients admitted to an asthma outpatient clinic of an education and research hospital and 23 non-smoking healthy control subjects were included in this study. An asthma questionnaire, spirometric tests, monitoring of PEF variability during two weeks, non-specific bronchial challenge test with methacoline, skin prick tests (SPT) with common aeroallergens, measurements of serum total IgE and blood eosinophil counts were applied to all cases. Results. Sixty of one hundred patients were diagnosed with asthma, whereas the 40 remaining participant were accepted as pseudoasthma due to a diagnosis of another cause for their symptoms. The sensitivity and specificity of the methacholine challenge test was 96.5% and 78.4%, respectively. While the most sensitive test was a methacholine challenge test, the most specific test was the reversibility test. The test with the highest correlation of a positive result and asthma was the reversibility test. However, the highest correlation with a negative result was found with the methacholine challenge test. SPT positivity, serum total IgE and eosinophilia had low sensitivity and moderate specificity. The most specific question was “have you had an attack of shortness of breath that came on during the day when you were at rest at any time?”, whereas the most sensitive question was “have you had an attack of shortness of breath that came on following strenuous activity at any time?” In addition, the questions “have you had an attack of shortness of breath that came on following strenuous activity at any time?” and “have you woken up with an attack of wheezing at any time?” had significant correlation with the results of the methacholine challenge test. Conclusions. We have shown that the methacholine challenge test is the most valuable diagnostic tool for asthma. In addition, there is a significant correlation between the methacholine challenge test and some patient symptoms.

Caesarean section and gastrointestinal symptoms, atopic dermatitis, and sensitization during the first year of life

Aims To investigate the effect of Caesarean section on gastrointestinal symptoms, atopic dermatitis and sensitization to nutritional allergens in infants.Methods A total of 865 healthy full‐term neonates with parental history of allergy participating in the prospective German Infant Nutritional Intervention Program (GINI) were exclusively breastfed during the first four months of life and had a one year follow‐up. Data were obtained by follow‐up visits at age 1, 4, 8, and 12 months, weekly diaries for the first six months, and measurement of total and specific IgE at birth and 12 months.Results Infants born by Caesarean section (147/865, 17%) had a greater risk of diarrhoea (ORadj 1.46, 95% CI 1.022–2.10) and sensitization to food allergens, both in adjusted (ORadj 2.06, 95% CI 1.123–3.80) and stratified analyses (by cord blood IgE). Caesarean delivery was not associated with colicky pain and atopic dermatitis.Conclusion Caesarean delivery might be a risk factor for diarrhoea and sensitization in infants with family history of allergy. Further research in this area seems warranted as choosing Caesarean section becomes increasingly popular.

Caesarean section and gastrointestinal symptoms, atopic dermatitis, and sensitisation during the first year of life

Aims: To investigate the effect of caesarean section on gastrointestinal symptoms, atopic dermatitis, and sensitisation to nutritional allergens in infants. Methods: A total of 865 healthy full term neonates with...